I recently visited a male massage provider (works out of a massage place) in Canada.  During our time I performed unprotected fellatio on him but there was no other contact.  From my reading I'm at risk of oral gonorrhea and syphilis and of course since this isn't standard practice for me now I'm anxious and intend to get tested.  It has been three weeks since our encounter and I have been looking in my mouth for chancres; at 19 days I noticed a something that looks like a raised white spot at the very back of my throat near the tonsils and has been there for days.  I have been obsessing over it ever since because I know this is the time frame in which a chancre would appear.  I have contacted the provider and he has stated that he's clean and takes care of himself.  I also didn't notice any problems with his penis - sores or pus etc.  So my questions as follows:

#1. Given the above should I be worried? did I win the oral syphilis lottery or is this likely something else and I'm just getting worked up about nothing? 

#2. Is it possible to transmit syphilis in the absence of a chancre?

#3. I guess I have to wait a few weeks before I can be tested and get a proper result? Or test now and test again? 

#4. Should I avoid being intimate with my partner?

Thanks for any help/advice.

Statistically, the chance of any STI from any single event of this sort is very low. Oral STIs in general, and oral gonorrhea in particular, rarely cause symptoms. Most likely you're examining yourself too closely; the "raised white spot" might be normal, and it certainly isn't gonorrhea. Syphilis? Conceivably, but a "white spot" isn't typical for syphilis and statistically very unlikely as well. Beyond the statistics, most people are good at assessing their own STI status, and most don't lie about it. So your massage partner's comments should be reassuring as well. To your specific symptoms:

1) I really wouldn't be worried. But because of that worry, and on general principles, it makes sense to be tested for syphilis and HIV; and to have a throat swab test for gonorrhea. (Chlamydia testing is almost always done along with gonorrhea, but it doesn't readily infect the throat and therefore even more unlikely.)

2) Yes, lesions other than chancres can transmit syphilis, and some asymptomatic infections can be transmitted. That's one reason testing is a good idea despite the low risk.

3) 80-90% of people newly infected with syphilis have positive blood tests within 3 weeks, so it's reasonable to be tested now. Same for HIV. For both infections, however, a second test at 6 weeks is necessary for conclusive results. But negative results at this time will be very reassuring, if not quite conclusive.

4) Difficult personal choice. As noted, the chance you have anything from the event described is very low, and will be truly miniscule if you are tested now as just recommended. You might then reasonably go ahead with your normal sexual practices with your partner -- but with awareness of a very small chance of having to disclose later, if later tests are positive. But that's every unlikely, and if somehow I were in your situation, I would go ahead with that if your first round of tests are negative.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

A few quick follow-ups.

#1. I will of course get an HIV test, but I'm surprised you're recommending it? I was under the impression that HIV was not transmitted orally?   FYI I have been monogamous up to this point and this is the only risky thing I have done.

#2. Should I refrain from kissing? Could Syphilis be spread through saliva during kissing?

2) Syphilis can be transmitted by kissing, but it's very rare. You needn't hesitate to kiss your partner, assuming that's what's on your mind.